Related Experiment Video
Updated: Sep 17, 2025
07:30
Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
Published on: June 15, 2019
10.1K
Corticosteroids in septic shock: a double-edged sword.
1Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Current Opinion in Critical Care
|June 30, 2025
Summary
Corticosteroid therapy for septic shock is debated. While guidelines suggest its use, especially for refractory cases, individualized treatment is crucial due to uncertain benefits and potential harms.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacology
Background:
- Corticosteroid therapy in septic shock is controversial.
- Glucocorticoids offer potential immunomodulatory benefits and can address hypothalamic-pituitary-adrenal (HPA) axis dysregulation.
- Conflicting clinical trial results create uncertainty in treatment guidelines and raise concerns about adverse effects.
Purpose of the Study:
- To review and interpret current evidence on corticosteroid use in septic shock.
- To explore the role of glucocorticoids in managing septic shock.
- To identify future research directions for corticosteroid therapy in this condition.
Main Methods:
- Systematic review and interpretation of existing clinical evidence.
- Analysis of data from clinical trials and systematic reviews.
- Assessment of current guidelines and prescribing practices.
Main Results:
- Current guidelines recommend corticosteroids for septic shock.
- Emerging data from community-acquired pneumonia (CAP) and acute respiratory distress syndrome (ARDS) may influence septic shock outcomes.
- Combination therapy with fludrocortisone shows potential benefits, requiring further investigation.
- Significant variability exists in corticosteroid prescription patterns among clinicians and intensive care units (ICUs).
Conclusions:
- The utility of corticosteroids in septic shock remains uncertain.
- Corticosteroids are valuable for refractory shock in selected patients when benefits exceed risks.
- Future research should prioritize personalized approaches to corticosteroid administration in septic shock.
Related Concept Videos
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
208
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
208
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
399
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
399
01:26COPD: Management Using Bronchodilators and Corticosteroids
324
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
324
01:17Pericarditis III: Medical Management
30
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
30
01:26Heart Failure Drugs: Inotropic Agents
743
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
743
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
277
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
277